+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension

Stress Doppler echocardiography in systemic sclerosis: evidence for a role in the prediction of pulmonary hypertension

Arthritis and Rheumatism 65(9): 2403-2411

Patients with systemic sclerosis (SSc) in whom pulmonary hypertension (PH) is not suspected have been reported to develop an inappropriate increase of pulmonary artery systolic pressure as estimated by Doppler echocardiography under conditions of exercise (pulmonary artery systolic pressure under exercise). We undertook this study to investigate whether this increase or any other parameter detectable by stress Doppler echocardiography has utility in predicting the development of PH in SSc. We enrolled a total of 170 patients with SSc previously investigated using standard and stress Doppler echocardiography and tissue Doppler imaging. Each patient was evaluated at baseline and yearly for skin and internal organ involvement. Right-sided heart catheterization was carried out when PH was suspected. The baseline Cochin Risk Prediction Score was calculated retrospectively. During followup, 6 patients (3.5%) developed PH. Compared with patients without any feature suggesting PH, the Cochin Risk Prediction Score was higher in this group (mean ± SD 4.2 ± 0.9 versus 3.4 ± 0.9; P < 0.05), as was the difference between pulmonary artery systolic pressure under exercise and pulmonary artery systolic pressure (Δpulmonary artery systolic pressure) (18.2 ± 7 mm Hg versus 9.4 ± 6.5 mm Hg; P < 0.001), even when adjusted for cardiac index changes. In multivariate analysis, Δpulmonary artery systolic pressure (hazard ratio [HR] 3.4 [95% confidence interval 1.4-8], P < 0.01) and Cochin Risk Prediction Score within the fifth quintile of the values registered in our series (HR 9.3 [95% confidence interval 1.4-63.7], P < 0.05) were the only factors independently predictive of PH during followup. A Δpulmonary artery systolic pressure cutoff of >18 mm Hg, identified by receiver operating characteristic curve analysis, had a sensitivity of 50% and a specificity of 90% for the development of PH during followup. An inappropriate response to exercise among patients with SSC is detectable by stress Doppler echocardiography. Independently of other clinical associations, increased Δpulmonary artery systolic pressure heralds PH. Stress Doppler echocardiography may represent an additional screening tool for this severe complication.

(PDF emailed within 0-6 h: $19.90)

Accession: 036928487

Download citation: RISBibTeXText

PMID: 23754201

DOI: 10.1002/art.38043

Related references

Stress Doppler echocardiography for early detection of systemic sclerosis-associated pulmonary arterial hypertension. Arthritis Research and Therapy 17: 165, 2016

Pulmonary hypertension in systemic sclerosis Identification by Doppler echocardiography and clinical features. Arthritis & Rheumatism 36(9 SUPPL ): S132, 1993

Exercise Doppler echocardiography identifies preclinic asymptomatic pulmonary hypertension in systemic sclerosis. Annals of the New York Academy of Sciences 1108: 291-304, 2007

Comparison of Doppler echocardiography and right heart catheterization to assess pulmonary hypertension in systemic sclerosis. British Journal of Rheumatology 36(2): 239-243, 1997

Exercise doppler echocardiography (ex-echo) as a tool to detect pulmonary arterial hypertension (PAH) in systemic sclerosis (SSC) patients in a pre-clinic asymptomatic phase. 2006

Early right ventricular systolic dysfunction in patients with systemic sclerosis without pulmonary hypertension: a Doppler Tissue and Speckle Tracking echocardiography study. Cardiovascular Ultrasound 8: 3, 2010

Exercise stress echocardiography for detection of pulmonary arterial hypertension in a patient with systemic sclerosis. Revista Portuguesa de Cardiologia 25(2): 199-203, 2006

Noninvasive prediction of pulmonary hypertension induced by hypoxic breathing in subjects susceptible to high altitude pulmonary edema by doppler echocardiography and the role of prostanoids. Japanese Circulation Journal 52(9): 1023, 1988

Noninvasive prediction of pulmonary hypertension in chronic obstructive pulmonary disease by Doppler echocardiography. Chest 91(3): 361-365, 1987

Echocardiography and pulmonary function as screening tests for pulmonary arterial hypertension in systemic sclerosis. Rheumatology 43(4): 461-466, 2004

CT pulmonary angiography combined with echocardiography in suspected systemic sclerosis-associated pulmonary arterial hypertension. Rheumatology 50(8): 1480-1486, 2011

Echocardiography may help detect pulmonary vasculopathy in the early stages of pulmonary artery hypertension associated with systemic sclerosis. Cardiovascular Ultrasound 8: 25, 2010

Accuracy of Doppler echocardiography in the hemodynamic assessment of pulmonary circulation in patients with systemic sclerosis. Advances in Medical Sciences 64(2): 309-314, 2019

Early detection of pulmonary hypertension in systemic sclerosis by exercice echocardiography. 2006

Can Exercise Echocardiography Predict the Development of Pulmonary Hypertension in Systemic Sclerosis?. Chest Journal 148(4): 925a-925b, 2015